Examination of temporal effects of adverse childhood experiences on mentally (rev. 0.85) unhealthy days
While public awareness of mental health challenges has grown significantly in recent decades, barriers to seeking treatment persist, including social stigma and personal hesitation. This report investigates how early life experiences—specifically adverse childhood experiences (ACEs)—may influence mental health outcomes across the lifespan. By examining the relationship between self-reported mentally unhealthy days, age, and ACEs, we explore whether the psychological impact of childhood trauma diminishes over time or persists into adulthood. Additionally, we consider how demographic factors such as race and gender may moderate these relationships, providing insights into the long-term trajectories of mental health outcomes for individuals with ACEs.
This report includes data from the 2023 Behavorial Risk Factors Surveillance System, a survey conducted annually by the CDC. THe full BRFSS dataset and supplementary materials are available at the CDC website.
Data was taken from the CDC’s 2023 BRFSS data set.
The 2023 BRFSS sample includes approximately 433,000 individuals. After accounting for non-responses and refusals, 60% report having no mentally unhealthy days to report, which means 40%—nearly half—experienced at least one such day in the past month. Further, out of the total sample, 86% can be categorized as Not Mentally Distressed, where distress is defined as having between 15 to 30 mentally unhealthy days (MUDs) in the last month. This means 14% of respondents, or 58,069 people, can be categorized as Distressed. Finally, of all respondents, only 7% reported experiencing at least one adverse childhood experience (ACE) during childhood ??.
Figure 1: Percentage of respondents who experienced at ACE, FMD or MUDs
While the initial prevalence rates might appear encouraging—with only 7% of respondents reporting adverse childhood experiences (ACEs)—this relatively small percentage warrants careful consideration rather than relief. The low prevalence of ACEs should not overshadow their potential long-term impact. Of particular interest is how this seemingly small group might experience disproportionate levels of mental health challenges and distress over time. The key question is not just how many people experienced ACEs, but rather how these early experiences may amplify vulnerability to mental health challenges and psychological distress throughout life. This analysis aims to examine whether individuals with ACEs, despite being a numerical minority in our sample, bear a disproportionate burden of mental health challenges and distress compared to those without such experiences.
Before examining the long-term effects of ACEs on MUDs, a Spearman correlation between MUDs and age revealed a coefficient of -0.17—small enough to be considered “very weak” and statistically insignificant. Nevertheless, the negative coefficient suggests an inverse relationship: as age increases, mentally unhealthy days tend to decrease.
Although mentally unhealthy days (MUDs) tend to decrease with age on average, this report examines whether adverse childhood experiences (ACEs) disrupt this natural trend. Specifically, we investigate whether ACEs can cause MUDs to persist later in life when they would typically have diminished.
The ACE section of the 2023 BRFSS study consists of thirteen questions. The first eleven questions directly address adverse experiences, while the final two are framed positively (e.g., “Did an adult provide for your needs?”). These last two questions were included in ACE calculations, as negative responses indicate childhood adversity, making them functionally equivalent to positive responses on questions 1-11.
Analysis shows that those who reported at least one ACE experience more days of poor mental health than those who did not experience an ACE. A Welch’s two-sample t-test revealed a statistically significant difference in the mean number of mentally unhealthy days between individuals who experienced ACEs and those who did not (t = -3.4, df = 42,241, p = 6e-04). Individuals with ACEs reported a mean of 4.5 mentally unhealthy days, significantly higher than the 4.3 days reported by those without ACEs. The 95% confidence interval for the difference in means ranged from -0.3 to -0.1 ??.
| Variable | Value |
|---|---|
| Mean MUDs (No ACE) | 4.3 |
| Mean MUDs (ACE) | 4.5 |
| t-statistic | -3.4 |
| df | 42,241 |
| p-value | 6e-04 |
| 95% CI Lower | -0.3 |
| 95% CI Upper | -0.1 |
Furthermore, despite the overall percentage of respondents who reported at least one ACE being low (7%), out of that 7%, the number who experienced more than one ACE is high (65%) 1.
The concerning implication of these findings are that since ACEs tend to cluster, those individuals are at much higher risk of mental unwellness. The following section explores potential public health implications, particularly focusing on how multiple ACEs might interact with mental health outcomes across a lifespan.
Add SectionNote: Learn the math of linear regression models and figure out how to compute the relationship between ACE on MUDs over TIME (age). Possible copy: “In other words, the trauma a child faces (at lease of the types denoted in the BRFSS questionnaire) tend to be far more potent and indelible, marking the child psychologically in a way that time alone does not seem to heal. This result is in striking opposition to the initial finding that, although weak indeed, the data indicates that MUDs decreases, naturally, over time. Further study should be pursued to determine if community, religion, or therapy might eleviate the wounds ACEs can impose.” |
Analysis of the Adverse Childhood Experiences (ACEs) data reveals distinct patterns in the prevalence of different types of childhood adversities. As illustrated in Figure X, among respondents who reported at least one ACE, exposure to swearing or verbal abuse was the most commonly reported experience, accounting for 17.8% of all reported ACEs. This was followed closely by having divorced parents (14.5%) and experiences of physical abuse (13.7%). The data also shows that household-level challenges, such as alcoholism (12.8%) and depression (10.3%), formed a substantial portion of reported adversities. Less frequently reported, but notably present, were experiences of sexual abuse and severe neglect, with ‘needs not met’ being the least commonly reported ACE at 0.8% of total responses. This distribution provides crucial insights into the relative frequency of different types of childhood adversities and highlights the predominance of verbal abuse and family structure disruptions in the sample.
Figure 2: Distribution of Adverse Childhood Experiences by Type
While the prevalence data shows how common different ACEs are, it doesn’t tell us about their relative impact on mental health outcomes. For instance, though sexual abuse is reported less frequently than verbal abuse, its psychological impact could be more severe. To investigate this, we analyzed the relationship between each type of ACE and both the average number of Mentally Unhealthy Days (MUDs) and the likelihood of experiencing Frequent Mental Distress (FMD, defined as 15-30 mentally unhealthy days per month).
Add SectionNOTE: The next step is to see which each individual ACEs affect on MUDs. Here’s my premise: perhaps it might be true that far fewer children experience sexual abuse rather than swearing but which one is more harmful according to mentally unhealthy days? And which ones experience the most FMDs? Does this change for gender or sex? Next Steps:
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Calculated from the subset of ACE-positive respondents (n=31,294), where 20,341 individuals reported multiple ACEs: (20,341/31,294) × 100 = 65%↩︎